Abstract
Current clinical application of thrombolysis in stroke is limited by the 4.5 hour time window and not applicable to patients with wake up stroke (WUS). Patient selection using advanced penumbral imaging criteria may allow extension of the therapeutic window. The EXtending the time for Thombolysis in Emergency Neurological Deficits (EXTEND) trial aims to test the hypothesis that perfusion-core mismatch can be used to select patients with favourable response to thrombolysis beyond conventional time windows. EXTEND is an investigator initiated, randomised, double-blind, placebo controlled phase 3 trial of intravenous alteplase versus placebo in patients with ischemic stroke 4.5–9 hours from stroke onset and WUS (defined as the midpoint between time to sleep and awakening with the stroke symptoms 6 seconds and a perfusion:core ratio of >1.2 with core volume
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